Provider Demographics
NPI:1336787043
Name:JIMMY QUANG OD INC
Entity type:Organization
Organization Name:JIMMY QUANG OD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-637-9987
Mailing Address - Street 1:31401 RANCHO VIEJO RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1850
Mailing Address - Country:US
Mailing Address - Phone:510-637-9987
Mailing Address - Fax:949-443-3828
Practice Address - Street 1:31401 RANCHO VIEJO RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1850
Practice Address - Country:US
Practice Address - Phone:949-443-3794
Practice Address - Fax:949-443-3828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-12
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty